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By Daniel Dunaief

Daniel Dunaief

Like it or not, ready or not, we will be starting August at the end of this week. That means many students and faculty will be returning to college, for those schools that are welcoming students back to campus and for however long those young learners will be allowed to remain there.

So, what should be on the shopping list?

Well, for starters, the kids will need masks and abundant quantities of hand sanitizer. Sure, colleges are promising to have some of each scattered around the facilities students will have to take turns using, but, to the extent we can find and afford it, we should include these health care items on our packing list.

They’ll probably need their own thermometers, just so they can respond, at a moment’s notice, to the question of how they are feeling and whether they’ve had any fever. In fact, they should carry the thermometer to every class.

Of course, this often isn’t sufficient in the age of COVID-19, in large part because so many people, particularly those who are our children’s age, don’t have a fever even if they are carriers and potential super-spreaders of the virus.

They’ll also need plenty of cleaning supplies because they may prefer to clean their rooms and common spaces like bathrooms themselves or because schools may be reluctant to send other people into their suite or hallway bathrooms.

We might want to add a laminated card that includes critical phone numbers and addresses. If they are far enough from home, they might need a safe place to stay in case they have to vacate campus immediately, like an antiseptic barn or a never-used cabin in the woods. They also might need to know the name and phone number of a local doctor or a doctor from home who can talk them through any medical challenges through telemedicine. Waiting at university health services, urgent care facilities, or hospitals may create undo stress and raise exposure to the virus.

Now, how many weeks or months of clothing to pack has become a matter of opinion. Some people, like my daughter, are listening to their school suggestion and are planning to pack for a total of three weeks. In that case, one or even one-and-a half suitcases may be sufficient.

Okay, what else? Well, they’ll need electronics and chargers, so they can do most of their work from their dorm room or a pre-reserved room in a library or any other space students can reserve that is cleaned in between study sessions.

Given that the gym, where they might go to run or lift weights, is likely on restricted hours or is only available for school athletes, they might also want to bring a few light weights, just to get some exercise in the room.

Even though they may only be there for three weeks, they’ll need plenty of air freshener and bug spray. If these students and their roommates spend most if not all of their time in their rooms, they may eat most, if not all, of their meals in this small space. Unless they take regular, exercise-inducing trips to remove their trash, the leftovers will likely start to smell within a few days, particularly in hotter rooms that don’t have air conditioners.

These students will also need cameras and plenty of memory in their electronic devices. If they only get three weeks or less of time on campus, they’re probably going to want to document as much as possible of their campus life, before they do all of their learning remotely.

Oh, and they might need a few notebooks, pencils and pens. Then again, if they do everything online, those antiquated items might be unnecessary in a year of unknowns.

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By Leah S. Dunaief

Leah Dunaief

What’s it like to be a grandparent?

Most of us would say it’s totally wonderful. But it’s not automatic. It’s a club we can’t join on our own. Only through our children’s actions can we be admitted, and for some people, their children are reticent to provide admission. Getting married in one’s 20s and shortly thereafter starting to have children is not the automatic course of events it once was in the last and previous centuries. For others with no children of their own, the surrogate route is available, and that can be deeply satisfying.

I can share with you some of the personal satisfactions. I am grandmother to four, who are in their teens and early 20s. Watching them grow and flower has been as much a miracle to me as their births, and they have expanded my horizons even as they have found their own paths. From my oldest grandson, I have learned a bit about making films since he has become a filmmaker. As you may know, we have even teamed up and collaborated on his movie, “One Life to Give,” about Benjamin Tallmadge, Nathan Hale and the Culper Spy ring.

From my second grandson’s work, I am thrilled to hear how music is made and then distributed to the public. This is his chosen career and our family is enjoying every note. My granddaughter is in college and expresses an interest in psychology, a field in which I have, to my regret, never taken any courses and am eager to learn more about. She is also a marvel to me because she is the first daughter among a team of sons to come along in a couple of generations. And my youngest grandson, still in high school, and I share a passion for baseball. Our only difference: he plays, I watch. And cheer.

Perhaps a less generally articulated satisfaction of being a grandparent is watching our children become parents. They have moved into those roles with the same eagerness and trepidation that their father and I felt. They now know what it is like to put aside their lives for another. As they have done so, they have understood and, I believe, come to appreciate their father and me, which is a nice aside.

Grandparents get to love their grandchildren without any baggage. We can enjoy their development without as much ego and effort as the first time around. We can play with them when they are little, then give them back to their parents when they need some attention. The remarkable thing about that relationship is how much they seem to love us, right from their first breaths on earth.

Grandparents also are the repositories of the culture, origins and values of the family. They offer a link between past and present, and often it is they who bring together families and community with their Sunday dinners and holiday gatherings.

Where are the grandparents now and how are they doing?

Grandparents have been perhaps the most isolated by COVID-19. In the age group deemed most likely to die from the disease, they have been the most careful about staying at home. As a result, grandparents have become almost invisible over the past four months. The only respite for some has been FaceTime or Zoom. If they have the technology, at least they can connect with family and friends digitally.

To honor grandparents and make them more visible during the pandemic, we are producing a special publication in time for Grandparents Day, a national holiday started by Marian McQuade of West Virginia and made official by President Jimmy Carter in 1978. We are inviting residents to send in pictures of their grandparents, and we will print them in the issue of Sept. 10. September was considered appropriate for such a celebration by the Carter administration since grandparents are in the autumn of their lives. And we consider it appropriate to salute them now for their difficult sheltering-in-place.

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By Linda Toga, Esq.

Linda Toga, Esq.

THE FACTS: Ever since I purchased my property, my neighbor had allowed me to drive over his property to get to my garage since the driveway that is on my property is very narrow and difficult to navigate. I am concerned that when my neighbor dies or sells his property, I will no longer be able to use the driveway that passes over his property. He told me he is willing to sell me the strip of his property that I am currently using.

THE QUESTION: Is this the best way to proceed?

THE ANSWER: Unless your neighbor owns a very large parcel of land that is subject to subdivision, I would be surprised if he would be allowed to simply sell you a piece of his property. Even if his property could be legally subdivided, it is unlikely that he could sell you a parcel that is smaller than the standard building lots in your area.

Rather than seeking a subdivision, I suggest that your neighbor grant you an easement over his property that runs with the land. In other words, he could grant you the right to use a specific part of his property for a specific purpose and indicate that the obligations and benefits created by the easement shall be enjoyed by subsequent owners of both your property and his own.

If your neighbor is amenable to creating an easement, the first thing that would have to be done is to have a surveyor map out the area that you will be allowed to use and prepare the legal description of that area. He should then retain an attorney to prepare an easement agreement that sets forth the details of your continued use of the area and the rights and obligations of whoever may own each of the subject properties now and in the future.

The agreement must contain sufficient information to identify the properties involved and the area comprising the easement. The agreement must then be recorded against both your property and your neighbor’s property so that future owners of both properties are on notice of the existence of the easement and their rights and obligations.

Once properly recorded, you will have the right to use the designated area of your neighbor’s property as a driveway for as long as you own your property and future owners will enjoy the same benefits you now enjoy.

Linda M. Toga, Esq provides legal services in the areas of real estate, estate planning and administration, small business services and litigation. She is available for email and phone consultations. Call 631-444-5605 or email Ms. Toga at [email protected] She will respond to messages and emails as quickly as possible.

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By Elof Axel Carlson

Elof Axel Carlson

In the life sciences, progress works incrementally.

The cell theory, for example, began in the 1600s with the observation of a cellular composition of cork bark with one the first microscopes. There was no cell theory (all the organisms we see are composed of cells) until 1838. The cell doctrine (cells arise from preexisting cells) came a generation later in the 1850s. A decade later, stain technology was introduced. In the 1930s electron microscopes were introduced. Molecular biology wasn’t introduced until the 1950s.

With each incremental advance, new tools, new data and new experiments are carried out. This can result in new insights on how life works, and it can be applied to disease in humans and other living things.

We manipulate life when we treat it because nature has no doctors or living things are at the whim of luck for their survival and evolution allows the healthiest, the most adapted, to survive and pass on their lucky genes. But today’s scientists can use a great deal of that incremental knowledge and apply it to our benefit.

One lead I find very exciting to read about and I am confident the next generation of science students will be excited by the advances taking place — It is now possible to begin a field of molecular neurology. The physiology of nerve cells is well worked, and we know how nerve impulses are transmitted and how reflexes form, and many other experimental approaches have provided an understanding of normal and diseased functioning of the nervous system. But the genes involved have been elusive.

Two fields have been added to the arsenal of approaches for exploring this. One is the field of stem cell research. The other is the use of fruit flies as model organisms to study the molecular genetics of fruit fly brains. Flies have the advantage of a limited number of activities that can be explored. They have courtship rituals, they have innate responses to gravity or to light, and they have vision, hearing, and taste as well as response to pain.

Some of the biochemical pathways in fruit flies are also found in humans and there is a surge of interest in using two approaches. One is finding chemicals  that shift slumbering stem cells into active nerve cells. This would allow treatments in coming years for neuromuscular disorders like multiple sclerosis. It could also slow down the aging process in which our stem cells lose the capacity to replace aged and dying neurons in the brain causing senility and other neurological disorders like Parkinson disease.

I am also a realist and historian of science. I know that such imagined future worlds can take decades or generations to achieve. We do not live in a totally known universe, and we only know a fraction of the way life has evolved over 3 billion years on earth. But by studying gene mutations involved with neuron formation and function, of stem cell activation, and of how humans can devise interventions for our health, we can feel confident that a lot more useful knowledge will emerge.

My realist side also tells me that all knowledge can be abused and we have learned to enact legislation to regulate most of our scientific and technological and malevolent intentions or warped values so that some do not exploit new technologies and shut down the progress needed to enlighten us and benefit us in an always troubled world.

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University.

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By Daniel Dunaief

Daniel Dunaief

Everyone has a social cup that they need to fill. Some have cups the size of shot glasses or even thimbles and can satisfy their need for social interactions with a few exchanges of pleasantries on a walk or by picking up the phone and dialing friends in town or across the country.

Each day, these people meet their own social needs with relative ease and without spending much time looking family, friends, neighbors and even strangers in the eye and telling their tales.

Others, however, need to fill large mugs that may be the size of enormous water bottles. They need to hear and tell jokes, to exchange thoughts and ideas, to laugh with others about their jobs, their kids, or the successes and failures of their cooking efforts, their favorite teams or the unbelievable acts of kindness or insensitivity they have witnessed.

Recently, my wife and I listened, outside and while socially distanced, to a friend of ours who lives with a larger social cup describe the abject misery he feels from working at home. The conditions don’t bother him and his children, who are grown up and living their lives and aren’t wandering into the picture when he gets on a zoom call.

For him, the challenge resides in the lack of contact with other people. When my wife and I suggested he call college friends and reach out to other people, he said he’d tried, but part of the problem is that they don’t have much to discuss.

Part of the problem is the Groundhog Day nature of his and everyone else’s life. Sitting at home and working, and taking a few breaks a day to walk his dogs, he hasn’t lived the way he’d like so he can gather the kinds of stories that refill that cup.

Later in that same week, my wife and I were flicking through the channels and saw CNN deriding President Donald Trump (R), while Fox was supporting the president and tearing into the presumptive Democratic challenger for the presidency, Joe Biden.

We have long lived in the world of outrage culture, where what passes for news and analysis has become an opportunity for experts to rip an issue, a person, an idea, a movement or anything apart that they can.

I picture the TV producers looking at their line up of articulate but angry people in suits each morning, trying to pick the best one to stir the pot, rile up the viewers and warn the world about the dangers that await them.

We don’t have many modern day versions of Mr. Rogers because calm, cool and collected doesn’t play as well as outraged and angry.

But, here’s the thing: people at home who haven’t filled their social cups may direct their discomfort and angry energy in destructive ways.

I get it: angry people with strong opinions likely bring in strong ratings for news organizations that have become instruments of advocacy. After all, few people sold newspapers or watched TV shows without a hint of drama or conflict.

In our lives, however, we have enough of conflict and drama, thank you very much.

With people struggling to deal with so much uncertainty and isolation and holding empty and dried out cups that reflect how much they miss familiar contact and connection, a soothing and calm presence that supports solutions rather than tearing down other people’s ideas, is far preferable to shows that foment anger.

With a contentious election on the horizon in which some portion of the population will be utterly crestfallen after the electoral votes are counted, we need news organizations to offer the kind of hope and solutions that doesn’t make people feel as if they’re holding an empty cup.

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By Leah S. Dunaief

Leah Dunaief

Most of us like to try to peer into the future and see what may lie ahead. That’s one attraction of a world’s fair and of futurist books. One such popular book of half a century ago was “Future Shock,” by Alvin Toffler, which dealt with how people can adapt to changes and even embrace them. During this coronavirus pandemic, the first such in 100 years, consensus seems to be that life will be changed after the disease ends, that this is a defining moment in
our history.

But how will things change?

A columnist for The New York Times, David Leonhardt, tried to provide a few answers this past Sunday in his article entitled. “It’s 2022. What does life look like?” Here is some of what he has to say that you and I can probably agree with, understanding that the timing of a vaccine can, in turn, alter the most clairvoyant of predictions.

Many traditional department stores will disappear. Already weakened by specialty stores like Home Depot or discount stores like Costco, the one-stop of Sears and J.C. Penny have been bypassed by shoppers, who have also embraced the convenience of the internet. Walmart and Amazon are among the world’s richest public companies today. Retailers in general have been stricken by the consumer move to online shopping. As investment guru Warren Buffett has been often quoted, “It’s only when the tide goes out that you learn who’s been swimming naked.”

Retail stores that have just managed to hang on will now experience a death blow. This could be devastating for shopping malls that depend on retailers’ rent. Of course, after a vaccine frees people to go shopping as something more like recreation, those retailers who provide an “experience” along with their goods for sale will have a better chance of surviving and even thriving. The demise of small retailers will have a huge impact on villages and unemployment, I believe. Many residents across the country work in their local stores.

Another change will be in higher education, according to Leonhardt. Dozens of colleges, private and public, despite being heavily subsidized by government, are in trouble. There are a couple of reasons. While college enrollment has pretty consistently been growing in the United States since the Civil War, in the last decade undergraduate numbers have fallen, the result of fewer births and, I believe, of a reconsideration of the value of pricey college education. Colleges have lost the revenue from summer school, from food service and parking fees. Of greatest concern is the imminent reduction of state aid due to stricken state budgets. The big question now is whether colleges will be able to bring back students for fall classes. If they cannot return, revenue is likely to drop sharply. Remote learning was not as successful or satisfying as was hoped. This could have severe implications for the educational level of the next generation of Americans.

The positive side of the remote coin can be found among white collar workers, many of whom will prefer to work at least part of the week from home in the future. There will be less business commuting, less travel with attendant fatigue, less cost. But that will negatively affect commercial real estate, the airlines and hotels.

The third at-risk industry, in Leonhardt’s view is local newspapers. “Between 2008 and 2019, American newspapers eliminated about half of all newsroom jobs. The virus has led to more job cuts — and could end up forcing dozens more papers to fold … If that happens, their cities will be left without perhaps the only major source of information about local politics, business, education and the like.” To what end? “Corruption and political polarization tend to rise while voter turnout tends to fall,” says Leonhardt. In short, the community begins to shrivel.

The solution, as we see the future, is to embrace change and make it work for us. That is why we here at the local newspapers are also the popular news website, tbrnewsmedia.com with almost 150,000 unique viewers a month. We are the sponsors of several social platforms and the innovators of such valued print products as the 2020 graduation supplement and the TBR Artists Coloring Book released in the last month alone. With, and only with your support, we at Times Beacon Record News Media are here to stay.

Sangria is a fruit punch-esque cocktail that’s best enjoyed on a sunny, lazy summer afternoon. METRO photo

By Bob Lipinski

Bob Lipinski

When it’s hot outside I’m looking for a beverage that’s light, refreshing, chillable, perhaps somewhat acidic to cleanse my palate, but most of all … it contains alcohol.

I enjoy wine and during hot weather I have found ways to convert that glass of wine into a “wine cooler.” Here are some of my summer coolers:

A spritzer (popular in the 1970s) is a tall drink made with a base of wine (white, red or rosé) and filled with a carbonated mixer (seltzer, tonic water, ginger ale) and sometimes garnished with lemon, lime, orange, a sprig of mint, or even a cherry. Spritzers are served on ice.

One of my favorite wine coolers is a kir. It’s an apéritif drink made with crème de cassis (black currant liqueur) and dry white wine, named after the late mayor of the city of Dijon, France, Canon Félix Kir (1876-1968). Kir was the favorite drink of the mayor from the 1940s until his death in 1968.

Originally, kir was made by mixing Aligoté, a highly acidic white wine from Burgundy with a tablespoon of crème de cassis, served chilled. Nowadays, just about any white wine used as Aligoté is difficult to find.

To make a kir, pour 1 ounce (2 tablespoons) of crème de cassis (black currant liqueur) into 5 to 6 ounces of a dry white wine, add ice and stir.

There are many variations of this drink: Kir Royale, along with Cardinal (cassis and Beaujolais), Kir Communist (cassis and red wine), and Kir Imperial (raspberry liqueur instead of cassis and champagne).

An all-time favorite that is making a big comeback is Sangría, originally from Spain. Now you can buy premade versions or make your own, which is more fun and allows for your creativity.

Sangria is a refreshing apéritif made from a mixture of wine (red, white, or rosé), slices of citrus fruits (lemon, lime, and orange), sugar, and sometimes soda water. To make Sangria, take a bottle of a dry red, white, or rosé wine. Add one lemon, lime, orange, and apple (cored) cut into quarters, then squeezed. To this add 1/4 cup superfine sugar. Mix all ingredients (including the quartered fruit) and refrigerate for several hours. Add ice before serving and top with a Maraschino cherry.

One of my favorite ways to keep ice cubes from diluting the wine is to freeze left-over wine (red or white) in ice cube trays, then seal in plastic bags so you will always have a few cubes on hand for wine coolers. (You can even mix colors.)

Bob Lipinski is the author of 10 books, including “101: Everything You Need To Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on Wine, Spirits, and Food and is available for speaking engagements. He can be reached at www.boblipinski.com OR [email protected].

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By Daniel Dunaief

Daniel Dunaief

Look, we’re out of practice. It’s totally normal. We’ve spent so much time talking to kids who don’t listen, to pets who need a break from us and to computers that seem determined to sabotage our efforts to work from home that we may have lost a step or two in our social graces.

Slowly, like hermit crabs emerging from their shells, we are stepping out into the phased world, in which we can do this, but can’t do that and where we are seeing more three-dimensional people and not those two-dimensional figures who flash across all manner of electronic devices.

As a quick refresher, I’d like to offer a reminder of the things that should give us pause if we’re about to share them with others who may be a bit sensitive.

The following should serve as verbal red flags:

Not that I’m looking, but … if whatever comes next is something you shouldn’t be staring at, such as anatomical areas, private letters or emails, you shouldn’t finish the sentence.

Don’t take this the wrong way … well, if a part of you recognizes that what you’re about to say could be problematic or painful for the listener, consider saying it in a different way or not saying it at all.

Obviously … this can go in one of two directions. A truly obvious statement doesn’t need sharing. A statement you think is obvious but isn’t so clear to the listener becomes a way to offend that person, who may have a reflexive defensive response.

I’m no expert, but … we all often talk about subjects in which we have no expertise. We might be anywhere from slightly informed to ill informed. We should be able to share what we think we might know, but we may not want to challenge someone who designs buildings on the best way to put together a LEGO house.

This is such a minor point that I hesitate to bring it up … maybe instead of hesitating, you should just not. Correcting the day of the week on a story about an event that occurred over 10 years ago seems unnecessary and distracting.

I don’t want to take the wind out of your sails … you’re probably about to do what you say you’re not doing, so own it and say you disagree completely or let me continue to sail off into my happy sunset.

What do I know, but … This expression suggests that you are about to do one of two things. You’re likely preparing to deliver serious criticism, but want to couch it by suggesting that it might not be based on anything other than a disdain for you, your wardrobe choices, your career path, or anything in between. Alternatively, you’re about to say something that seems supportive — “what do I know, but your idea for submersible homes seems compelling to me”  — but that really suggests that you’re hiding behind false humility. If someone follows your advice, the “what do I know” expression is your way of dodging any responsibility for their mistakes.

I don’t mean to offend you, but … this is one of my favorites. It suggests that you know you are about to be offensive and that you don’t mean it, but you just can’t help it. You’re about to share something that may dress up as helpful, like a Trojan horse, perhaps, but that will likely cause damage.

Holding our tongues can be incredibly difficult, especially when we’d like to tell the person in front of us how we want to make a minor, but likely obvious point that we hope doesn’t take the wind out of their sails or offend them. We also don’t know what we’re talking about because we’re not experts. Still, it was sort of good to see them.

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By Leah S. Dunaief

Leah Dunaief

Those businesses that qualified for a paycheck protection program (PPP) loan have had a bit of a honeymoon from the novel coronavirus these last eight weeks. They were allowed to apply to the government for two months plus 50 percent of their labor costs. From that money they had to pay at least 60 percent to workers to cover payroll, with the remainder underwriting other expenses like utilities, payroll taxes and leases.

So the employers who received the payments could relax during those two months, and the employees could also stop holding their breaths, knowing that their salaries would be paid. And the government would keep the workers employed. At least that was how it was supposed to work, and it did, except when the weekly unemployment insurance payments were greater than the weekly salaries and proved too much of a temptation to the employee. In those cases, the employer was in competition with the government and, depending on the worker’s loyalty and long term concern about holding onto a job, the employer would often lose. 

But the program was essentially a good one. The funds, paid to the businesses and-in turn to their employees, kept the work force together and saved the workers from the frustrations of trying to collect unemployment. 

The original thinking was that the pandemic would probably lessen after two months and businesses could resume as normal. Well, we now know how that turned out. The pandemic is still with us, although New York is in a much better condition at the moment than most of the rest of the country, but economic activity has not returned to anything like normal, and with social distancing, looks unlikely to return soon. 

For many of those businesses, the PPP honeymoon is almost over. How do we prevent a return to the layoffs, loss of company health insurance and nail biting of the pre-PPP days? 

The good thing about a pandemic is that the whole world is in the same situation, and we can look around and see how other countries are coping or trying to cope. The U.S. has relied on an expanded program of unemployment insurance to tide over workers until the economy resurrects itself. Many European countries have prevented joblessness by essentially nationalizing payrolls and enabling workers to continue to be paid and businesses to resume whenever that happy day comes, without having to rehire and possibly retrain. Workers are often furloughed if there is no work at the shuttered shops and factories, meaning that their jobs will be held for them and they continue to receive their salary, although generally at a reduced amount. 

In short, Europeans have been pursuing an extended PPP. Workers have not overwhelmed the unemployment insurance system, caused websites to crash, phones to go unanswered, lost health coverage, nor have they stood the requisite six feet apart in the hot sun on long lines in parking lots, waiting to get into benefit offices. There is also the intangible but priceless advantage of workers not feeling jobless, with the fear and loss of identity that often brings. 

And today, many feel just that. The U.S. number in June for jobless was 11.1 percent. That’s an increase of some eight percent since February. In the aforementioned European countries, the jobless rate has increased by less than 1 percent. In human terms, that means some 20 million Americans are unemployed. While that’s better than 23 million in April, probably almost all of those people have families who also will feel the effects as tenants begin to be evicted and queues form for food banks. 

We don’t know what is going to happen in the next few weeks, as government programs for business and unemployment benefits run out if not extended. The $600 federal unemployment boost is supposed to end July 31. Congress is debating whether to extend the time or modify the payout, even as some worry that paying workers more than their salary is a disincentive to work.

Just remember, we are in this together. Hang on and stay safe.

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Early diagnosis is crucial to treatment success

By David Dunaief, M.D.

Dr. David Dunaief

Diabetic retinopathy is an umbrella term for microvascular complications of diabetes that can lead to blurred vision and blindness. There are at least three different disorders that comprise it: dot and blot hemorrhages, proliferative diabetic retinopathy and diabetic macular edema. The latter two are the ones most likely to cause vision loss. Our focus for this article will be on diabetic retinopathy as a whole and on diabetic macular edema, more specifically.

Diabetic retinopathy is the number one cause of vision loss in those who are 25 to 74 years old (1). Risk factors include duration of diabetes, glucose (sugar) that is not well-controlled, smoking, high blood pressure, kidney disease, pregnancy and high cholesterol (2).

What is diabetic macula edema, also referred to as DME? Its signature is swelling caused by extracellular fluid accumulating in the macula (3). The macula is the region of the eye with greatest visual acuity. A yellowish oval spot in the central portion of the retina — in the inner segment of the back of the eye —it is sensitive to light. When fluid builds up from leaking blood vessels, there is potential for vision loss.

Those with the longest duration of diabetes have the greatest risk of DME (4). Unfortunately, many patients are diagnosed with DME after it has already caused vision loss. If not treated early, patients can experience permanent loss of vision (5). Herein lies the challenge.

In a cross-sectional study (a type of observational study) using NHANES data from 2005-2008, among patients with DME, only 45 percent were told by a physician that diabetes had affected their eyes (6). Approximately 46 percent of patients reported that they had not been to a diabetic nurse educator, nutritionist or dietician in more than a year — or never.

The problem is that the symptoms of vision loss don’t necessarily occur until the latter stages of the disorder. According to the authors, there needs to be an awareness campaign about the importance of getting your eyes examined on an annual basis if you have diabetes. Many patients are unaware of the association between vision loss and diabetes.

Treatment options                                             

While DME is traditionally treated with lasers, intravitreal (intraocular — within the eye) injections of a medication known as ranibizumab (Lucentis) may be as effective.

The results from a randomized controlled trial, the gold standard of studies, showed that intravitreal (delivery directly into the eye) injections with ranibizumab, whether given prompt laser treatments or treatments delayed for at least 24 weeks, were equally effective in treating DME (7).

Increased risk with diabetes drugs

You would think that drugs to treat type 2 diabetes would prevent DME from occurring as well. However, in the THIN trial, a retrospective (backward-looking) study, a class of diabetes drugs, thiazolidinediones, which includes Avandia and Actos, actually increased the occurrence of DME compared to those who did not use these oral medications (8). Those receiving these drugs had a 1.3 percent incidence of DME at year one, whereas those who did not had a 0.2 percent incidence. This incidence was persistent through the 10 years of follow-up. [Note that DME is not the only side effect of these drugs. There are important FDA warnings of other significant issues.]

To make matters worse, those who received both thiazolidinediones and insulin had an even greater incidence of DME. There were 103,000 diabetes patients reviewed in this trial. It was unclear whether the drugs, because they were second-line treatments, or the severity of the diabetes itself may have caused these findings.

This is in contrast to a previous ACCORD eye sub-study, a cross-sectional analysis, which did not show an association between thiazolidinediones and DME (9). This study involved review of 3,473 participants who had photographs taken of the fundus (the back of the eye).

What does this ultimately mean? Both of these studies were not without weaknesses. It was not clear how long the patients had been using the thiazolidinediones in either study or whether their sugars were controlled and to what degree. The researchers were also unable to control for all other possible confounding factors (10). Thus, there needs to be a prospective (forward-looking) trial done to sort out these results.

Diet

The risk of progression of diabetic retinopathy was significantly lower with intensive blood sugar controls using medications, one of the few positive highlights of the ACCORD trial (11). Medication-induced intensive blood sugar control also resulted in increased mortality and no significant change in cardiovascular events. But an inference can be made: A nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy complications (12, 13).

The best way to avoid diabetic retinopathy is obviously to prevent diabetes. Barring that, it’s to have sugars well-controlled. If you or someone you know has diabetes, it is imperative that they get a yearly eye exam from an ophthalmologist so that diabetic retinopathy is detected as early as possible, before permanent vision loss occurs. It is especially important for those diabetes patients who are taking the oral diabetes class thiazolidinediones.

References:

(1) Diabetes Care. 2014;37 (Supplement 1):S14-S80. (2) JAMA. 2010;304:649-656. (3) www.uptodate.com. (4) JAMA Ophthalmol online. 2014 Aug. 14. (5) www.aao.org/ppp. (6) JAMA Ophthalmol. 2014;132:168-173. (7) ASRS. Presented 2014 Aug. 11. (8) Arch Intern Med. 2012;172:1005-1011. (9) Arch Ophthalmol. 2010 March;128:312-318. (10) Arch Intern Med. 2012;172:1011-1013. (11) www.nei.nih.gov. (12) OJPM. 2012;2:364-371. (13) Am J Clin Nutr. 2009;89:1588S-1596S.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.